主要组织相容性一类相关链A基因抗体与慢性移植肾功能减退的相关性研究  

Relationship of post-transplant MICA antibodies and chronic renal allograft function decline

作　　者：钟键[1] 侯建全[1] 何军[2] 王乾[1] 袁晓妮[2] 温端改[1] 

机构地区：[1]苏州大学附属第一医院泌尿外科,215006 [2]苏州大学附属第一医院血液科江苏省血液研究所

出　　处：《中华泌尿外科杂志》2009年第3期163-167,共5页Chinese Journal of Urology

基　　金：基金项目：国家自然科学基金资助项目（30872530）;江苏省自然科学基金资助项目（BK2007056）;江苏省卫生厅重点人才资助项目（RC2007079）

摘　　要：目的探讨肾移植术后主要组织相容性一类相关链A基因（MICA）抗体对稳定期移植肾功能的影响。方法采用免疫荧光液相芯片技术检测57例肾移植术后超过半年患者的MICA抗体水平及特异性，并同时检测SCr水平，分析MICA抗体对移植肾功能的影响。结果57例患者中HLA抗体和MICA抗体均为阴性者38例，HLA抗体阳性、MICA抗体阴性者11例，HLA抗体阴性、MICA抗体阳性者5例，HLA抗体和MICA抗体均阳性者3例。在MICA特异性抗体不同类型中，MICA019抗体5例、MICA027抗体3例、MICA018抗体2例、MICA004和017抗体各1例，MICA抗体阳性值≥6分者3例，占75％（9／12）。MICA抗体阳性组8例与MICA抗体阴性组49例在术前输血史、淋巴毒试验、冷缺血时间、术后时间方面差异均无统计学意义（P〉0．05）；而在术时年龄方面差异有统计学意义[（32．5±7．9）岁与（43．0±10．4）岁（P=0．008）]。MICA抗体阳性HLA抗体阴性组SCr水平[（117．20±12．30）μmol／L]及SCr异常比例（5／5）均高于HLA抗体和MICA抗体均阴性组[（89．40±28．95）μmol／L及23．7％（9／38），P〈0．051。结论肾移植术后监测MICA抗体可作为肾移植HLA阴性患者预后重要的标志物，并且MICA抗体与慢性移植肾功能减退存在明显的相关性。Objective To explore the relationship of post-transplant major histocompatibility complex class Ⅰ chain-related gene A（MICA） antibody status and renal allograft function in clinical stable phase. Methods Fifty-seven patients accepted renal allografts followed up for at least 6 months were detected with the levels and specialties of MICA antibodies by Flow PRATM beads. Simultaneously, their serum creatinine levels were tested as well. The impact of MICA antibody status on renal allograft function was assessed. Results Among the 57 patients, 38 cases showed no HLA and MICA antibody, 11 cases had HLA antibodies but not MICA antibody, 8 cases had MICA antibodies and 3 cases had both MICA and HLA antibodies. There were 5 patients with MICA019 anti- bodies, 3 patients with MICA027 antibodies, 2 patients with MICA018 antibodies, while 1 patient with MICA004 and MICA017 antibodies, respectively. There were 9 patients with antibody positive score higher than 6, accounting 75% （9/12）. Except age, there was no significant difference between patients with positive and negative MICA antibodies in the aspects of blood transfusion history, CDC, and cold ischemia time （P〉0.05）. The average ages were （32.5 ± 7. 9） years for MICA antibody- positive patients and were （43. 0± 10. 4） years for MICA antibody-negative patients （P = 0. 008）. MICA antibody-positive patients without HLA antibody had higher serum creatinine level [（117.20± 12.30）μmol/L] than MICA and HLA antibody-negative patients [（89. 40± 28. 95）μmol/L, P〈 0.05]. Conclusions The measurement of MICA antibodies has prognostic value in the assessment of patients without HLA antibodies after renal transplantation. MICA antibody positive has clear association with chronic renal allograft function decline.

关 键 词：肾移植 主要组织相容性一类相关链A基因抗体 HLA抗体 移植肾功能 

分 类 号：R686[医药卫生—骨科学]